AAPD Reference Manual 2022-2023

RESOURCES: MEDICAL EMERGENCIES

Management of Medical Emergencies

For all emergencies 1. Discontinue dental treatment

4. Monitor vital signs

2. Call for assistance / someone to bring oxygen and emergency kit 3. Position patient: ensure open and unobstructed airway

5. Be prepared to support respiration, support circulation, provide CPR, and call

for emergency medical services

Condition

Signs and symptoms

Treatment

Drug dosage

Drug delivery

Hives; itching; edema; erythema–skin, mucosa conjuctiva

1. Discontinue all sources of allergy-causing substances 2. Administer diphenhydramine This is a true, life-threatening emergency 1. Call for emergency medical services 2. Administer epinephrine 3. Administer oxygen 4. Monitor vital signs 5. Transport to emergency medical facility by advanced medical responders 1. Sit patient upright or in a comfortable position 2. Administer oxygen 3. Administer bronchodilator 4. If bronchodilator is ineffective, administer epinephrine 5. Call for emergency medical services with transportation for advanced care if indicated 1. Assess and support airway, breathing, and circulation (CPR if warranted) 2. Administer oxygen 3. Monitor vital signs 4. Call for emergency medical services with transportation for advanced care if indicated 1. Reassure patient 2. Assess and support airway, breathing, and circulation (CPR if warranted) 3. Administer oxygen 4. Monitor vital signs 5. Call for emergency medical services with transportation for advanced care if indicated 1. Assess and support airway, breathing, and circulation (CPR if warranted) 2. Administer oxygen 3. Monitor vital signs 4. If severe respiratory depression, establish IV access and reverse with flumazenil 5. Monitor recovery (for at least 2 hours after the last dose of flumazenil) and call for emergency medical services with transportation for advanced care if indicated

Diphenhydramine: follow manufacturer’s instructions based on child’s age/weight Epinephrine (1 mg/mL): 0.01 mg/kg every 5 minutes until recovery or until help arrives 1

Oral

Allergic reaction (mild or delayed)

Urticaria-itching, flushing, hives; rhinitis; wheezing/difficulty breathing; bronchospasm; laryngeal edema; weak pulse; marked fall in blood pressure; loss of consciousness

IM or SubQ (Auto injector available)

Allergic reaction (sudden onset): anaphylaxis

Shortness of breath; wheezing; coughing; tightness in chest; cyanosis; tachycardia

1. Albuterol (patient’s or emergency kit inhaler) 2. Epinephrine (1 mg/mL): 0.01 mg/kg every 15 minutes as needed 1

Inhale

Acute asthmatic attack

IM or SubQ

Light-headedness; changes in vision and/or speech; metallic taste; changes in mental status; confusion, agitation; tinnitis; tremor; seizure; tachypnea; bradycardia; unconsciousness; cardiac arrest

Supplemental oxygen

Mask

Local anesthetic toxicity

Anxiety; tachycardia/ palpitations; restlessness; headache; tachypnea; chest pain; cardiac arrest

Supplemental oxygen

Mask

Local anesthetic reaction: vasoconstrictor

Somnolence; confusion; diminished reflexes; respiratory depression; apnea; respiratory arrest; cardiac arrest

Flumazenil 0.01 mg/kg (maximum: 0.2 mg); may repeat at 1 minute intervals not to exceed a cumulative dose of 0.05 mg/kg or 1 mg, whichever is less 1

IV (if IV access is not available, may be given IM)

Overdose: benzodiazepine

Abbreviations in table: CPR = cardiopulmonary resuscitation; IM = intramuscular; IN = intranasal; IV = intravenous; kg = kilogram; mg = milligram; mL= milliliter; SubQ = subcutaneous.

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THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY